Method for interconnecting longitudinal members extending along a spinal column

ABSTRACT

A method of interconnecting first and second longitudinal members extending along a spinal column of a patient includes inserting an access port into the body of the patient. A transverse connector is moved through the access port. A first end of the transverse connector is connected to the first longitudinal member. A second end of the transverse connector is connected to the second longitudinal member.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.10/969,124, filed Oct. 20, 2004 (pending), which claims the benefit ofU.S. Provisional Application No. 60/513,013, filed Oct. 21, 2003 and areboth incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to a method and a transverse connector forinterconnecting first and second longitudinal members extending along aspinal column, and more specifically, to a method and a transverseconnector for interconnecting first and second longitudinal membersextending along a spinal column during a minimally invasive surgery.

BACKGROUND OF THE INVENTION

Minimally invasive surgery is a procedure in which surgical instrumentsare inserted through an access port, a tubular structure, a retractor,or a cannula into the body of a patient. A known minimally invasivesurgery allows longitudinal members, such as rods, to be connected tovertebrae of a spinal column through an access port. The rodsinterconnect adjacent vertebrae of the spinal column. While the abovedescribed method enables adjacent vertebrae of a spinal column to befixed relative to each other, the interconnecting of the longitudinalmembers has heretofore been conducted by a much more invasive opensurgical method.

SUMMARY OF THE INVENTION

The present invention relates to a method and a transverse connector forinterconnecting first and second longitudinal members extending along aspinal column of a patient. An access port, tubular structure,retractor, or cannula is inserted into the body of the patient. Atransverse connector is moved through the access port. A first end ofthe transverse connector is connected to the first longitudinal member.A second end of the transverse connector is connected to the secondlongitudinal member.

The transverse connector for interconnecting the first and secondlongitudinal members includes a first end connectable with the firstlongitudinal member. A second end is connectable with the secondlongitudinal member. A connecting rod connected to the first and secondends extends between the first and second ends. The connecting rod isrotatable about a longitudinal axis of the connecting rod relative tothe first end and pivotable about a pivot axis extending transverse tothe longitudinal axis. A fastener connects the connecting rod to thefirst end in connecting rod and in any one of a plurality of pivotpositions about the pivot axis. The connecting rod is also positionablealong the longitudinal axis of the connecting rod relative to the firstend. The transverse connector may interconnect longitudinal membersextending at an angle of up to approximately 45° relative to each other.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features of the present invention will becomeapparent to one skilled in the art to which the present inventionrelates upon consideration of the following description of the inventionwith reference to the accompanying drawings, in which:

FIG. 1 is an enlarged plan view of transverse connectors of the presentinvention interconnecting a pair of longitudinal members which areconnected to a spinal column;

FIG. 2 is a pictorial view of the transverse connector in FIG. 1;

FIG. 3 is an enlarged plan view of the transverse connector of FIG. 1with portions cut away to show how a connecting rod of the transverseconnector is pivoted relative to a first end of the transverseconnector;

FIG. 4 is a schematic sectional view showing an access port during aminimally invasive surgical procedure for interconnecting thelongitudinal members with the transverse connector of FIG. 2;

FIG. 5 is a schematic view of an access port for use during the surgicalprocedure to interconnect the longitudinal members with the transverseconnector;

FIG. 6 is a schematic view of another access port for use during thesurgical procedure to interconnect the longitudinal members with thetransverse connector;

FIG. 7 is a schematic sectional view showing another access port duringa surgical procedure for interconnecting the longitudinal members withthe transverse connector; and

FIG. 8 is a schematic sectional view showing first and second accessports during a surgical procedure for interconnecting the longitudinalmembers with the transverse connector.

DESCRIPTION OF THE INVENTION

The present invention is directed to a method and a transverse connectorfor interconnecting first and second longitudinal members extendingalong a spinal column of a patient. The method involves the use of anaccess port, a tubular structure, a retractor, or a cannula during aminimally invasive surgery.

A transverse connector 10 for interconnecting a pair of longitudinalmembers or rods 12 connected to vertebrae V of a spinal column isillustrated in FIGS. 1-3. Although the transverse connector 10 is showninterconnecting rods 12, it is contemplated that the transverseconnector may interconnect any suitable longitudinal member, such asplates or hexagonal-shaped rods. The rods 12 may be located anywherealong the spinal column and the location of the rods illustrated in FIG.1 is for example purposes.

Each of the rods 12 (FIG. 1) is elongate and has a sufficient length tospan at least two vertebrae V. A plurality of connectors 14 connect therods 12 with the vertebrae V. The connectors 14 may be of any known ordesired configuration. One suitable connector 14 is similar to aconnector shown in U.S. patent application Ser. No. 10/075,668, filedFeb. 13, 2003, incorporated herein entirely by reference. Other suitableconnectors are shown in PCT Application No. US03/04361, filed Feb. 13,2003, and U.S. patent application Ser. No. 10/483,605, filed Jan. 13,2004, which are incorporated herein entirely by reference.

The connectors 14 (FIG. 4) include housings 16 pivotable relative tofasteners 18. Set screws 20 threadably engage the housings 16 to clampthe rods 12 to the housings and prevent relative movement between thehousings and the fasteners 18.

At least one transverse connector 10 (FIG. 1) interconnects the rods 12.The transverse connector 10 blocks relative movement of the rods 12 sothat the vertebrae V connected to the rods are maintained in theirdesired relative positions and do not pivot relative to ananterior/posterior axis or a longitudinal central axis of the spinalcolumn. The transverse connector 10 increases the torsional strength ofthe rod construct to provide stability when the spinal column twists,such as when the shoulders are turned or angled relative to the legs ina standing position. The transverse connector 10 may be located anywherealong the rods 12 and any number of transverse connectors may be used.

The transverse connector 10 (FIGS. 1-3) includes a first connecting end30 connectable with one of the spine rods 12. The first end 30 (FIG. 2)has a recess 32 that receives a portion of the spine rod 12. A clampingmember or set screw 34 threadably engages the first end 30 and damps thespine rod 12 to the first connecting end 30 in the recess 32.

The first connecting end 30 (FIG. 3) has an opening 40 that extendsthrough a portion of the first connecting end. The opening 40 receives aconnecting rod 42 fixedly connected to a second connecting end 44 andextending from the second connecting end 44. The connecting rod 42 isintegrally formed with the second end 44. The opening 40 defines asocket 46 for receiving a ball 48 to define a ball joint 50. Theconnecting rod 42 extends through the ball 48 and into the opening 40 inthe first end 30. The connecting rod 42 is rotatable about alongitudinal axis 51 of the connecting rod and pivotable about a pivotaxis extending transverse to the longitudinal axis. The connecting rod42 may pivot about the pivot axis so that the transverse connector 10may interconnect rods 12 extending up to approximately 45° relative toeach other. The connecting rod 42 is also slidable relative to the ball48 along the axis 51 and thus is positionable in any one of a pluralityof positions along the longitudinal axis 51 relative to the firstconnecting end 30 and the ball 48.

The first connecting end 30 includes sidewalls 58 that extend generallyparallel to each other and transverse to the rod 12 when the rod 12 isconnected to the connecting end 30. Each of the walls 58 includes anopening 60. The openings 60 extend through the walls 58 and intersectthe opening 40. The connecting rod 42 may extend through the openings 60in the sidewalls 58, as shown in FIGS. 2 and 3.

The ball 48 has four tabs 62 engageable with the connecting rod 42. Aset screw 68 threadably engages the first connecting end 30 and clampsthe connecting rod 42 against the connecting end 30 to prevent movementof the connecting rod relative to the connecting end. Accordingly, theset screw 68 connects the connecting rod 42 to the first connecting end30 in any one of a plurality of positions about the longitudinal axis51, in any one of a plurality of pivot positions about the pivot axis,and in any one of a plurality of positions along the longitudinal axis51 of the connecting rod. It is contemplated that the connecting rod 42could threadably engage the ball 48 to position the connecting rodrelative to the ball.

The second connecting end 44 (FIG. 2) has a recess 76. The recess 76receives a portion of the other spine rod 12. A clamping member or setscrew 78 threadably engages the second connecting end 44 and clamps thespine rod 12 to the second connecting end 44 in the recess 76.

When the transverse connector 10 is to be connected to the spine rods12, the connecting rod 42 is placed through the ball 48. The connectingrod 42 is positioned relative to the connecting end 30. Once theconnecting ends 30 and 44 have been positioned relative to each otherand the spine rods 12, the rods 12 are placed in the recesses 32 and 76.The set screws 34, 68, and 78 are tightened to connect the connectingrod 42 to the connecting end 30 and the transverse connector 10 to thespine rods 12.

The transverse connector 10 may be moved through a device for providingaccess to a surgical location, such as an access port, tubularstructure, retractor, or cannula 100 to connect the transverse connectorto the rods 12. The access port, tubular structure, retractor, orcannula may have any desired configuration. One suitable cannula 100 issimilar to a cannula shown in U.S. Pat. No. 6,187,000, incorporatedherein entirely by reference. U.S. patent application Ser. No.09/772,605, filed Jan. 30, 2001, incorporated herein entirely byreference, discloses other cannula structures that may be used. U.S.patent application Ser. No. 10/926,840, filed Aug. 26, 2004, is alsoincorporated herein entirely by reference.

The cannula 100 is a tubular structure 112 defining a passage 116through the cannula. Surgical instruments and an endoscope may beinserted into a patient's body 118 through the passage 116 during aminimally invasive surgery to interconnect the longitudinal members 12with the transverse connector 10.

The tubular structure 112 includes a first or proximal tubular portion120 and a second or distal tubular portion 140 attached to the firsttubular portion. The first tubular portion has a proximal end 122 and adistal end 124. The second tubular portion 140 is pivotally connected tothe distal end 124 of the first tubular portion 120. The second tubularportion 140 includes a segment 142 of sheet stock. The segment 142 isrolled in an overlapping manner to form the tubular configuration of thestructure 112 is expandable from a contracted condition to an expandedcondition shown in FIG. 4. In the contracted condition, the secondtubular portion 140 is cylindrical in shape. In the expanded condition,the second tubular portion 140 has a frustoconical configuration.

During a minimally invasive surgical procedure, the cannula 100 (FIG. 4)may be inserted over a tissue dilator or obturator into the body of apatient in the contracted condition. The dilator is removed and anexpansion tool (not shown) is inserted into the passage 116 into thecannula 100 to expand the second tubular portion 140. The expansion toolis then removed from the cannula 100 so that one or more surgicalinstruments and the transverse connector 10 can be inserted through thecannula and inserted into the patient's body 118. The expanded tubularportion 140 can dilate and locally retract and separate spinalis muscleand soft tissues from the vertebrae V thereby creating an operatingfield at the surgical site.

The rods 12 may be connected to the vertebrae V by the connectors 14during a minimally invasive surgery. One suitable minimally invasivemethod for connecting the rods 12 to the vertebrae V is described inU.S. Pat. No. 6,530,926, incorporated herein entirely by reference. Afirst cannula 100 is inserted into the body of the patient 118. A firstfastener 18 is moved through the cannula 100 and secured to a firstvertebra V. A second fastener 18 is moved through the cannula 100 andsecured to a second vertebra V. A first longitudinal member or rod 12 isand second fasteners 18 by clamping members 20. A second cannula 100 isinserted into the body of the patient 118. A third fastener 18 is movedthrough the cannula 100 and secured to the first vertebra V. A fourthfastener 18 is moved through the second cannula 100 and secured to thesecond vertebra V. A second longitudinal member or rod 12 is movedthrough the second cannula 100. The second rod 12 is connected to thethird and fourth fasteners 18 by clamping members 20. It is contemplatedthat any number of fasteners may be moved through the first and secondcannula 100 to fix any number of vertebrae of a patient together.

After the rods 12 are connected to the vertebrae V, at least onetransverse connector 10 is moved through the second cannula 100 andconnected to the rods. The second tubular portion 140 (FIGS. 4 and 5) ofthe cannula 100 may include a door member 150 pivotally connected to thesegment 142 by a fastener 152. The door 150 may be pivoted relative tothe segment 142 to uncover a second passage or opening at a distal end154 of the second tubular portion 140 through which a surgicalinstrument 156 (FIG. 4), such as a side cutting Kerrison bone removalinstrument, may extend. The opening at the distal end 154 extendstransverse to the passage 116. The surgical instrument 156 may extendthrough the opening in the second tubular portion 140 to remove tissue,such as portions of a spinous process S, intraspinous ligament, and/orlamina, to create a passage P from one side of the spine mid-line to theother. After the portions of the spinous process S, intraspinousligament, moved through the cannula 100 and into the passage P. Thetransverse connector 10 extends through the passage P from one side ofthe spine mid-line to the other. The ends 30 and 44 of the transverseconnector 10 are connected to the rods 12 to interconnect the rods 12.

The cannula 100 may have a second passage or recess 160 (FIG. 6) formedin the distal end 154 of the second tubular portion 140. The recess 160extends transverse to the passage 116. The surgical instrument 156 mayextend through the recess 160 in the second tubular portion 140 toremove tissue, such as portions of a spinous process S, intraspinousligament, and/or lamina, to create a passage P from one side of thespine mid-line to the other. After the portions of the spinous processS, intraspinous ligament, and/or lamina have been removed, thetransverse connector 10 may be moved through the cannula 100 and intothe passage P. The transverse connector 10 extends through the passage Pfrom one side of the spine mid-line to the other. The ends 30 and 44 ofthe transverse connector 10 are connected to the rods 12 to interconnectthe rods 12.

The cannula 100 may be angled obliquely, as shown in FIG. 7, to provideaccess to the spinous process S, intraspinous ligament, and/or lamina.The surgical instrument 156 may be inserted through the second tubularportion 140 to remove tissue, such as portions of the spinous process S,intraspinous ligament, and/or lamina, to create a passage from one sideof the spine mid-line to the other. After the passage is formed, intothe passage. The transverse connector 10 extends through the passage andis connected to the rods 12 to interconnect the rods 12.

After the first and second rods 12 are connected to the vertebraethrough the first and second cannula 100, the first and second cannula100 may be angled obliquely, as shown in FIG. 8, to provide access tothe spinous process S, intraspinous ligament, and/or lamina. Thesurgical instrument 156 may be inserted through the second tubularportion 140 of one of the first and second cannula 100 to remove tissue,such as portions of the spinous process S, intraspinous ligament, and/orlamina, to create a passage P. After the passage P is formed, thetransverse connector 10 may be moved through one of the first and secondcannula 100 and into the passage P. The transverse connector 10 extendsthrough the passage P and is connected to the rods 12 to interconnectthe rods 12.

A tether 170 may be connected to the transverse connector 10 by asuitable connecting device 172. The transverse connector 10 may beinserted axially into the connecting device 172. The connecting device172 may grip the transverse connector 10 when the connecting device ispulled to try and remove the connecting device from the transverseconnector, similar to a Chinese finger trap device.

The tether 170 may extend through the first and second cannula 100 andthe passage P formed in the spinous process S, intraspinous ligament,and/or lamina. The tether may be pulled to guide the transverseconnector 10 through the first cannula 100 and into the passage P. Oncethe transverse connector 10 is inserted through the passage P, theconnecting device 172 may be removed from the transverse connector 10.The connecting ends 30 and 44 may be connected to the rods 12 tointerconnect the rods.

Although the cannula 100 is shown as having an expandable tubularportion 140, it is contemplated that any suitable access port, tubularstructure, retractor, or cannula, such as a tubular conduit having alarge enough passage for receiving the transverse connector 10, may beused during the minimally invasive surgery. It is also contemplated thatany other suitable device for interconnecting the rods 12 may be used tointerconnect the longitudinal members during the minimally invasivesurgery.

It will be understood that the above description of the presentinvention is susceptible to various modifications, changes, andadaptations, and the same are intended to be comprehended within themeaning and range of equivalents, of the appended claims. The presentlydisclosed embodiments, are considered in all respects to be illustrativeand not restrictive. The scope of the invention indicated by theappended claims, rather than the foregoing description, and all changesthat come within the meaning and range of equivalence thereof areintended to be embraced therein.

1. A method of inserting an elongate member for connecting vertebrae ofa patient, said method comprising: inserting a first access device intoa body of the patient at a first location; inserting a second accessdevice into the body of the patient at a second location; passing afirst end of a pulling member through the first access device and out ofthe second access device such that the first end of the pulling memberextends from the second access device and outside the body while asecond end of the pulling member extends from the first access deviceand outside the body; removably attaching an elongate member to thesecond end of the pulling member; pulling the first end of the pullingmember thereby pulling the elongate member through the first accessdevice; and connecting the elongate member to first and secondvertebrae.
 2. The method of claim 1, further including expanding aportion of the first and second access devices.
 3. The method of claim1, further including expanding a distal portion of the first and secondaccess devices.
 4. The method of claim 1, further including extending aninstrument through the first access device and removing tissue to createa passage from one side of a mid-line of a spinal column to another sideof the mid-line of the spinal column.
 5. The method of claim 4, whereinthe step of passing the pulling member includes passing the pullingmember through the first access device, across the passage from one sideof the mid-line of the spinal column to the side of the mid-line of thespinal column, and out the second access device.
 6. The method of claim5, further including pulling the pulling member through the passage topull the elongate member into the passage.
 7. The method of claim 1,further including angling the first and second access devices obliquely.8. The method of claim 1, further including moving a first fastenerthrough the first access device and securing the first fastener to thefirst vertebra.
 9. The method of claim 8, further including moving asecond fastener through the first access device and securing the secondfastener to the second vertebra.
 10. The method of claim 9, furtherincluding moving a first longitudinal member through the first accessdevice and connecting the first longitudinal member to the first andsecond fasteners.
 11. The method of claim 10 including moving a thirdfastener through the second access device and securing the thirdfastener to the first vertebra.
 12. The method of claim 11, furtherincluding moving a fourth fastener through the second access device andsecuring the fourth fastener to the second vertebra.
 13. The method ofclaim 12, further including moving a second longitudinal member throughthe second access device and connecting the second longitudinal memberto the third and fourth fasteners.
 14. The method of claim 13, whereinthe step of connecting the elongate member to first and second vertebraeincludes connecting the elongate member to the first and secondlongitudinal members.
 15. The method of claim 1, further includingproviding a distal portion of the first access device with an opening,wherein the pulling member and elongate member are passed through theopening.
 16. The method of claim 15, further including covering theopening in the distal portion of the access device with a door.
 17. Themethod of claim 16, further including pivoting the door relative to theaccess device to uncover the opening.
 18. A method of inserting anelongate member for connecting vertebrae of a patient, said methodcomprising: inserting a first access device into a body of the patientat a first location; inserting a second access device into the body ofthe patient at a second location; passing an elongate flexible pullingmember through the first access device and out of the second accessdevice such that the pulling member extends from outside the body,through the first and second access devices and outside the body;removably attaching an elongate member to one end of the pulling member;pulling the other end of the pulling member thereby pulling the elongatemember through the first access device; and connecting the elongatemember to first and second vertebrae.
 19. The method of claim 18,further including expanding distal portions of the first and secondaccess devices.
 20. The method of claim 19, further including extendingan instrument through the first access device and removing tissue tocreate a passage from one side of a mid-line of a spinal column toanother side of the mid-line of the spinal column, wherein the step ofpulling the pulling member includes pulling the elongate member into thepassage.